Healthcare Provider Details

I. General information

NPI: 1093621443
Provider Name (Legal Business Name): KATHERINE WALD
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2502 10TH AVE S
MINNEAPOLIS MN
55404-4510
US

IV. Provider business mailing address

2502 10TH AVE S
MINNEAPOLIS MN
55404-4510
US

V. Phone/Fax

Practice location:
  • Phone: 612-813-8300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number27353
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: